運用主動偵測對早期發現抗藥性金黃色葡萄球菌移生之探討

Using Active Surveillance in the Early Detection of Methicillin-resistant Staphylococcus aureus Colonization

10.6224/JN.61.1.32

林佳蓉(Chia-Jung Lin)；陳瑛瑛(Yin-Yin Chen)

主動偵測 ； 抗藥性金黃色葡萄球菌 ； 移生 ； 照護 ； active surveillance ； methicillin resistant Staphylococcus aureus ； colonization ； care

護理雜誌

61卷1期（2014 / 02 / 01）

32 - 41

繁體中文

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is one of the principal pathogens implicated in hospital-acquired infections. Active surveillance of patients with MRSA colonization at admission may reduce the spread of the MRSA through contact precautions.Purpose: This study applies active surveillance to the early detection of MRSA colonization and to the determination of the risk factors of MRSA colonization.Method: A prospective cohort study was conducted at a medical center in North Taiwan from March 2010 to August 2010. Participants were recruited from among patients admitted to an infection department who were under active surveillance for culture within the 24-hour period following admission. Nose and environment samplings were taken every Monday and Thursday until participants were transferred, discharged, or expired.Result: This study enrolled 239 patients, with 182 included in data analysis. Positive nasal cultures were found on 53.3% of admitted patients during the initial 24-hour period, with 7.1% generating positive environmental cultures. During the nose and environment sampling phase, 27.4% and 19.2% of participants, respectively, generated positive nasal and positive environmental cultures. The average number of days required to provide a positive culture were 9.2 days for nasal cultures and 11.4 days for environmental cultures. Incidence density of nosocomial MRSA infections reduced by 0.47 per mille to 0.19 per mille. Univariate analysis identified using a nasogastric tube and using steroids as two statistically significant risk factors for positive nasal MRSA colonization (p ＜ .05). A multivariate analysis of risk factors showed a 2.68-times higher risk in participants admitted with pressure sores and 2.81-times higher risk in those who used steroids. The risk of participants acquiring MRSA during their stay was 6% per day.Conclusions: Active surveillance facilitates the early detection of MRSA colonization. Healthcare professionals should wear gloves and adhere to hand-hygiene and contact-precaution protocols when caring for damaged skin, especially pressure sores. Further, healthcare professionals should implement clean environment practices to control the spread of MRSA.

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is one of the principal pathogens implicated in hospital-acquired infections. Active surveillance of patients with MRSA colonization at admission may reduce the spread of the MRSA through contact precautions.Purpose: This study applies active surveillance to the early detection of MRSA colonization and to the determination of the risk factors of MRSA colonization.Method: A prospective cohort study was conducted at a medical center in North Taiwan from March 2010 to August 2010. Participants were recruited from among patients admitted to an infection department who were under active surveillance for culture within the 24-hour period following admission. Nose and environment samplings were taken every Monday and Thursday until participants were transferred, discharged, or expired.Result: This study enrolled 239 patients, with 182 included in data analysis. Positive nasal cultures were found on 53.3% of admitted patients during the initial 24-hour period, with 7.1% generating positive environmental cultures. During the nose and environment sampling phase, 27.4% and 19.2% of participants, respectively, generated positive nasal and positive environmental cultures. The average number of days required to provide a positive culture were 9.2 days for nasal cultures and 11.4 days for environmental cultures. Incidence density of nosocomial MRSA infections reduced by 0.47 per mille to 0.19 per mille. Univariate analysis identified using a nasogastric tube and using steroids as two statistically significant risk factors for positive nasal MRSA colonization (p ＜ .05). A multivariate analysis of risk factors showed a 2.68-times higher risk in participants admitted with pressure sores and 2.81-times higher risk in those who used steroids. The risk of participants acquiring MRSA during their stay was 6% per day.Conclusions: Active surveillance facilitates the early detection of MRSA colonization. Healthcare professionals should wear gloves and adhere to hand-hygiene and contact-precaution protocols when caring for damaged skin, especially pressure sores. Further, healthcare professionals should implement clean environment practices to control the spread of MRSA.